Early Versus Late Paravertebral Block for Analgesia in Video-Assisted Thoracoscopic Lung Resection. A Double-Blind, Randomized, Placebo-Controlled Trial

Objectives: Paravertebral local analgesia is effective in providing pain relief after video assisted thoracoscopic surgery. This randomized, double-blind pilot clinical trial investigated the effect of early perioperative delivery of paravertebral local analgesia to reduce postoperative pain after video assisted thoracoscopic lung resection and the feasibility of a larger trial. Design: Double-blind, randomized, placebo-controlled trial. Setting: University hospital, single institution. Participants: Patients over 18 years of age having video assisted lung resection surgery. Interventions: 90 patients undergoing video assisted lung resection were randomized to receive bupivacaine via paravertebral catheter either before lung resection (early; n = 47) or at the end of the operation (late; n = 43). The primary outcome measure was pain on coughing during the first 24 postoperative hours. The 95% confidence interval for a median difference was calculated using the Hodges-Lehman median difference method. Measurements and Main Results: There was no difference in pain scores between groups over the first 24 postoperative hours. The median (range) morphine equivalent consumption after 24 hours was 34 (7.3-105) mg with early paravertebral bupivacaine and 40.7 (3-91) mg after late paravertebral bupivacaine. The prevalence of chronic pain at 12 months postoperatively was 8.7% with early paravertebral bupivacaine and 25.8% with late paravertebral bupivacaine; the difference was not statistically significant. Conclusions: The authors found no difference in acute postoperative pain, but the decrease in morphine consumption and prevalence of chronic pain with early paravertebral bupivacaine, although not statistically significant, may warrant further investigation with a larger trial. (C) 2018 Elsevier Inc. All rights reserved.